Transcript PowerPoint Slides - North American Cystic Fibrosis

Plenary III:
There is No Health
Without Mental Health
Disclosures
• Alexandra Quittner
– Investigator-initiated grants: Novartis & Insmed
– Consultant to Vertex, AbbVie, and Novartis
– Research support from CF Foundation, EU, Australia NHMRC
• Stuart Elborn
– Clinical trials and consultancy with Novartis, Vertex,
Celtaxsys, Corbus
– Research support from MRC, EC Framework 7, CF Trust UK
– European CF Society
• Beth Smith
– Grant support from the Cystic Fibrosis Foundation and the
New York State Office of Mental Health
There Is No Health
Without Mental Health
Beth A. Smith, MD
University of Buffalo
School of Medicine and Biomedical Sciences
Buffalo NY USA
Mental Health Screening Recommendations
Indicated
Patient Population
Organization
Children, 11-21 yrs
American Academy of Pediatrics1
Adolescents & Adults
US Preventative Services Task Force2, 3
Adults
UK NICE Mental Health Guidelines 4
Cancer
American Society of Clinical Oncology5
Coronary Heart Disease American Heart Association6
Diabetes
American Diabetes Association7
1-Pediatr. 2014;133(3):568-570
2-Pediatr. 2009;123(4):1223-1228
3-Ann of Internal Med. 2009;151(11):784-792
4- BPS. 2010
5-Oncology. 2014;32(15):1605-1619
6- Circulation. 2008;118(17):1768-1775
7- Diabetes care. 2008;31 Suppl 1:S12-54.
From Consensus to Action
• We have a great opportunity to improve the
health and quality of life of our patients and
families
– But there is a lot of work to do!
• Currently, our capacity to provide
comprehensive mental health care is modest
How Are We Going To Do This?
Implementation Support
Guidance on What to Do and How to Do it
The International Committee on Mental Health in CF
Recommendations
Educational Materials
Implementation
The CF Foundation Mental Health Task Force
• A committee established by the CF Foundation
– Responsible for supporting implementation of the
International Mental Health Guidelines
– Our goal: accessible toolkits for implementation
• Produced CF Mental Health White Paper:
"Recommendations for CFF Support of Prevention,
Screening and Treatment of Anxiety and Depression
in Individuals with Cystic Fibrosis and Their Parent
Caregivers”
– Current scientific evidence
– Expert consensus
– Comprehensive analysis of centers currently
screening
Manual of Procedures and Toolkit for
Guideline Implementation
• Created at Buffalo, used by Lurie Children's
Hospital in Chicago to implement their
screening
• This tool assists the CF center in putting the
mental health guidelines into practice
– User friendly and applicable tool for real world CF
center practices
– Provides step by step information,
recommendations, educational resources, and
tools
– Tools are broadly relevant, easy to use, and free
Educational Materials for Staff
Pamphlets for Patients/Families
Additional Resources
• Psychotherapy
–
–
–
–
Manual: How to Create Referral Networks
Handouts on psychotherapy for patients/parents
Handout on CF for mental health care providers
Training: CBT Short Course
• Psychopharmacology
– Tabulation of 1st line medications recommended to
treat depression and/or anxiety 1
• Dosing, titration schedule, target doses
• Adjustments for renal and hepatic impairments
• Drug-Drug interactions
– Training: Psychopharmacology Short Course
1 Quittner et al. Thorax. October 2015; epub
Integrating Behavioral Health into the CF Clinic:
The Collaborative Care Model
• Establish a position of mental health coordinator
– (clinical social worker, psychologist, etc.)
• Task with developing and implementing
strategies for:
– Prevention
– Screening
– Case management for those needing interventions
• Provide direct care if trained in psychotherapy
CF Foundation RFA for
Mental Health Support
• Designed to facilitate implementation of the
Guideline recommendations
• Seed funding for a CF Foundation Mental
Health Coordinator
• Designated for hiring additional staff or
increase in FTE of existing staff who will focus
on mental health coordination or psychosocial
intervention
Summary
• Mental health is an unmet clinical need which can
positively affect CF disease management
• Mental Health Guidelines are a step to assist the
CF community in the assessment and treatment
of anxiety and depression
– Patients and families recognize this need and are
receptive to screening
• We have worked hard to remove implementation
barriers
– < 10 minutes to perform the screening
– CF Foundation Mental Health RFA provides a vehicle
to support these activities in CF Centers
There Is No Health Without Mental Health